Incidence and Risk Factors of Nausea and Vomiting after Exposure to Low-Osmolality Iodinated Contrast Media in Children: A Focus on Preparative Fasting

Abstract

Objective: To evaluate the incidence and risk factors of emetic complications associated with the intravenous administration of low-osmolality iodinated contrast media (ICM) in children undergoing computed tomography (CT). Materials and Methods: All children who underwent contrast-enhanced CT between April 2017 and July 2019 were included. Pediatric patients were instructed on the preparative dietary protocol at our institution. Experienced nurses in the radiology department monitored the children during the CT scans and recorded any emetic complications in their electronic medical records. These data were used to calculate the incidence of emetic complications. Various patient factors and technical factors, including fasting duration, the type and volume of ICM, and ongoing chemotherapy, were evaluated to identify risk factors for emetic complications using univariate and multivariate logistic regression analyses. Results: Among the 864 children (mean age, 8.4 ± 5.7 years) evaluated, 18 (2.1%) experienced emetic complications (6 experienced nausea only and 12 experienced nausea and vomiting). None of the children developed aspiration pneumonia. The mean fasting duration of patients with emesis was 7.9 ± 5.7 hours (range, 3-21 hours), whereas that of patients without nausea was 8.7 ± 5.7 hours (range, 0-24 hours). Fasting duration was not associated with the development of nausea and vomiting (p = 0.634). Multivariate logistic regression analysis revealed that ongoing chemotherapy (odds ratio [OR] = 4.323; 95% confidence interval [CI] = 1.430-13.064; p = 0.009), iomeprol use (OR = 7.219; 95% CI = 1.442-36.146; p = 0.016), and iohexol use (OR = 5.241; 95% CI = 1.350-20.346; p = 0.017) were independent risk factors for emetic complications. Conclusion: Only a small proportion (2.1%) of children experienced nausea or vomiting after exposure to low-osmolality ICM. Many children underwent excessive fasting; however, fasting duration was not associated with nausea and vomiting. Moreover, ongoing chemotherapy and the use of iomeprol or iohexol were identified as potential risk factors for emetic complications in children.

Change the preprocedural fasting policy for contrast-enhanced CT: results of 127,200 cases

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“…The decision-makers still face embarrassment and challenge due to unavailable standards, and decisions often rely on deep-rooted clinical experience. At present, the sample sizes of only a few researches were quite small [ 8 – 11 ], and the majority of them focused on a single patient population [ 8 , 9 , 12 ]. No hierarchical management of dietary preparation regimens for specific clinical scenarios was explored.…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

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“…Ha et al evaluated the incidence of emetic complications and their risk factors after intravenous LOCM administration in pediatric patients [ 32 ]. For patients who required oral sedation or who did not require sedation, the fasting duration from solids and non-clear liquids depended on their ages.…”